Abstract
BACKGROUND CONTEXT Due to the complexity and invasiveness of deformity correction, poor outcomes are often associated. Currently, it is unknown what factors predict an outcome which operation may not be warranted (reoperation, major complications, clinical deterioration). PURPOSE To investigate what patient factors justify determining a patient ineligible for a deformity correction. STUDY DESIGN/SETTING Retrospective review of a prospective, consecutively enrolled adult spinal deformity (ASD) database. PATIENT SAMPLE Operative patients with complete 2-year HRQL and radiographic data were included. OUTCOME MEASURES HRQLs: Oswestry Disability Index (ODI), complications; reoperations. METHODS Patients >18yrs undergoing surgery for ASD (scoliosis ≥20°, SVA ≥5cm, PT ≥25°, or TK ≥60°). An unsatisfactory outcome was defined by the following categories met at 2Y: (1) clinical: deteriorating in ODI at 2Y follow-up (2) complications/reop: having a reoperation and major complication were deemed unacceptable for surgery (NoOp). Baseline demographic, clinical and radiographic information were utilized through univariate/multivariate analyses to assess predictive factors of NoOp patients in adult spinal deformity patients. Multivariate regression with backward model selection was employed to create a model for when not to operate. RESULTS A total of 633 ASD patients (59.9 years, 79% F, 27.7 kg/m2, CCI: 1.74) were included. By approach, 0.6% were anterior, 69.7% posterior and 29.5% combined approaches, with a total number of levels fused as 7.5±2.1. Baseline severe Schwab modifier incidence (++): 39.2% PI-LL, 28.8% SVA, 28.9% PT. 15.5% of patients deteriorated in ODI by 2 years, while 7.6% underwent a reoperation and had a major complication. This categorized 11 (1.7%) of patients in the total cohort as NoOp. NoOp patients had were more comorbid in terms of arthritis (73%) heart disease (36%) and kidney disease (18%), p 65mm, C2 slope >30.2°, CTPA >5.5° for an R2 value of 0.535 (p CONCLUSIONS When addressing adult spine deformities, a negative outcome of clinical deterioration, major complications, and reoperations are exceedingly rare, but do occur. This tends to occur in severely comorbid patients with major baseline psychological distress scores, severe neurologic dysfunction and concomitant cervical malalignment not addressed at surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Published Version
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